Applicant Profile Hard Copy Printout Submit to: State of Alaska

Personal Information

First Name: _____________ Middle Initial: (Optional) ___

Last Name: _______________________

Mailing Address: _____________________________________

City: _________________________ State: ____ Zip Code: __________

Country: ________

Home Phone: *Area Code first (_____) ___________________

Work/Message Phone: *Area Code first (_____) ___________________

E-mail: *____________________________________
* Optional, but recommended for email confirmation and password recovery

Are you currently an Alaska Resident? Yes No
.....Since __________ (mm/yy)

Do you have a legal right to accept employment in the United States? Yes No

Have you complied with all the requirements of the Selective Service Act * ? Yes No
* www4.sss.gov/regver/register.asp

Effective Jan. 1, 2004, failure to answer "Yes" to this question will prevent an application from being submitted. Candidates may be required to show evidence of compliance.

Are you related to any person currently working for the State of Alaska? Yes No

.....If Yes, please list their name(s), their Department(s), and your relationship(s):

....._____________________________________________________________

Convictions:
A criminal conviction, whether misdemeanor or felony, will not automatically disqualify or exclude you from employment with the State of Alaska.

You are required to provide true and complete information during the recruitment and selection process.  If you intentionally or unintentionally conceal or otherwise provide a false statement of material fact in your application submission it will result in permanent loss of eligibility for employment with the State of Alaska per Personnel Rule 2AAC.07.112. 

Note: For purposes of application with the State of Alaska this includes all convictions, even if you have received and/or completed a Suspended Imposition of Sentence.
Have you ever been convicted of a felony? Yes No
Note: If you have been convicted of a felony, you will be required to provide a copy of your judgment if chosen for an interview.


Have you been convicted of a misdemeanor within the past five years? Yes No
If you answered Yes to either of the above questions, please explain below:








Education & Training
Education: Check highest level attained

High School	Post Secondary
Some High School HS Graduate or GED	Some College Associate's Degree Bachelor's Degree Master's Degree Doctorate

School Name	School Location	Areas of Study	Degrees obtained
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Certifications, licenses and date obtained:

Career-specific, job-related training and skills:

Experience:
Work History (Paid or Volunteer): List employers, starting with most recent (if more than four employers, use blank sheets of paper):

Employer #1 (of 4)
Name of employer and location:	|
Start Date: (Month/Day/Year)	|
Ending Date: (Month/Day/Year)	|
Job Title:	|
Supervisor's Name:	|
Supervisor's Phone Number:	|
Employment Type:	Full-Time Part-Time
Hours/Week worked:	|
Did your duties include supervision of others?	Yes No
If yes, you must specify the number of people supervised:
Type of people supervised:	Professional Administrative Paraprofessional Technical Clerical
Salary: (Monthly)	|

Description. Please describe your duties.

Employer #2 (of 4)
Name of employer and location:	|
Start Date: (Month/Day/Year)	|
Ending Date: (Month/Day/Year)	|
Job Title:	|
Supervisor's Name:	|
Supervisor's Phone Number:	|
Employment Type:	Full-Time Part-Time
Hours/Week worked:	|
Did your duties include supervision of others?	Yes No
If yes, you must specify the number of people supervised:
Type of people supervised:	Professional Administrative Paraprofessional Technical Clerical
Salary: (Monthly)	|

Description. Please describe your duties.

Employer #3 (of 4)
Name of employer and location:	|
Start Date: (Month/Day/Year)	|
Ending Date: (Month/Day/Year)	|
Job Title:	|
Supervisor's Name:	|
Supervisor's Phone Number:	|
Employment Type:	Full-Time Part-Time
Hours/Week worked:	|
Did your duties include supervision of others?	Yes No
If yes, you must specify the number of people supervised:
Type of people supervised:	Professional Administrative Paraprofessional Technical Clerical
Salary: (Monthly)	|

Description. Please describe your duties.

Employer #4 (of 4)
Name of employer and location:	|
Start Date: (Month/Day/Year)	|
Ending Date: (Month/Day/Year)	|
Job Title:	|
Supervisor's Name:	|
Supervisor's Phone Number:	|
Employment Type:	Full-Time Part-Time
Hours/Week worked:	|
Did your duties include supervision of others?	Yes No
If yes, you must specify the number of people supervised:
Type of people supervised:	Professional Administrative Paraprofessional Technical Clerical
Salary: (Monthly)	|

Description. Please describe your duties.